Abstract
Leukopenia or thrombocytopenia is sometimes observed in end-stage renal disease (ESRD) patients, but the association between chronic leukopenia or thrombocytopenia and hemodialysis (HD) is still unclear. We aimed to investigate the incidence of chronic leukopenia or thrombocytopenia in patients with ESRD who received HD and to determine the risk factors of this complication. We retrospectively analyzed ESRD patients treated with HD at Ditmanson Medical Foundation Chia-Yi Christian Hospital in 2018. The risk factors for the occurrence of chronic leukopenia and thrombocytopenia were analyzed by Cox regression models. Of the 473 patients in our study cohort, 46 (9.7%) patients had a hematologic abnormality, including 18 patients with chronic leukopenia, 18 with chronic thrombocytopenia, and 10 with pancytopenia. Multivariate analysis revealed that patient age ≥60 years at the initiation of dialysis was a significant predictor for both chronic leukopenia [adjusted hazard ratio (aHR), 2.71; 95% confidence interval (CI), 1.06-6.89] and chronic thrombocytopenia (aHR, 2.83; 95% CI, 1.08–7.35). Chronic liver disease (aHR, 3.31; 95% CI, 1.27–8.61) and serum ferritin levels >800 mg/dl (aHR, 3.29; 95% CI, 1.29–8.39) were risk factors for chronic thrombocytopenia. A trend showed that vitamin D from intravenous supplementation (aHR, 0.13; 95% CI, 0.01–1.16, P = 0.066) and serum phosphorous level (aHR, 0.73; 95% CI, 0.53–1.02, P = 0.068) may be associated with chronic thrombocytopenia. Our study demonstrated that hematological abnormality was a long-term complication of HD. These results reveal that older patients with HD and high serum ferritin levels are at an elevated risk for chronic cytopenia. Healthcare professionals should be aware of this risk when treating HD patients in order to improve their prognosis.
Highlights
Taiwan has one of the highest prevalence rates of end-stage renal disease (ESRD) in the world [1]
In the multivariate Cox analysis, age ≥60 years at the initiation of HD was an independent risk factor of chronic leukopenia
To the best of our knowledge, this is the first study to report that chronic leukopenia and thrombocytopenia are long-term complications of HD
Summary
Taiwan has one of the highest prevalence rates of end-stage renal disease (ESRD) in the world [1]. In 2018, the incidence rate of dialysis was 493 patients per million people in the general population in Taiwan [2,3,4]. The life expectancy of ESRD patients has been greatly improved by multidisciplinary patient education and highquality care [2, 5]. Long-term complications affect patients’ quality of life. Dialysis is associated with complications such as anemia, secondary hyperparathyroidism, and bone disorder [6]. Anemia is a well-known hematological problem in chronic kidney disease. The use of erythropoiesis-stimulating agents increases hemoglobin concentrations and improves patientperceived quality of life [7]
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